Farewell. The Flying Pig Has Left The Building.

Steve Hynd, August 16, 2012

After four years on the Typepad site, eight years total blogging, Newshoggers is closing it's doors today. We've been coasting the last year or so, with many of us moving on to bigger projects (Hey, Eric!) or simply running out of blogging enthusiasm, and it's time to give the old flying pig a rest.

We've done okay over those eight years, although never being quite PC enough to gain wider acceptance from the partisan "party right or wrong" crowds. We like to think we moved political conversations a little, on the ever-present wish to rush to war with Iran, on the need for a real Left that isn't licking corporatist Dem boots every cycle, on America's foreign misadventures in Afghanistan and Iraq. We like to think we made a small difference while writing under that flying pig banner. We did pretty good for a bunch with no ties to big-party apparatuses or think tanks.

Those eight years of blogging will still exist. Because we're ending this typepad account, we've been archiving the typepad blog here. And the original blogger archive is still here. There will still be new content from the old 'hoggers crew too. Ron writes for The Moderate Voice, I post at The Agonist and Eric Martin's lucid foreign policy thoughts can be read at Democracy Arsenal.

I'd like to thank all our regular commenters, readers and the other bloggers who regularly linked to our posts over the years to agree or disagree. You all made writing for 'hoggers an amazingly fun and stimulating experience.

Thank you very much.

Note: This is an archive copy of Newshoggers. Most of the pictures are gone but the words are all here. There may be some occasional new content, John may do some posts and Ron will cross post some of his contributions to The Moderate Voice so check back.

Thursday, July 26, 2012

HCR -- The Four Ways We Die

By John Ballard

One factor of America's extraordinarily high medical costs is our belief that dying is optional. Your death is inevitable, of course, but mine is not. I and those I love simply don't have to die. I'm being sarcastic, of course, but there is not a reader who doesn't get what I mean.

Most of us will not have the opportunity to just die of "old age" or to simply fall to sleep one night never to wake again. Most often, we develop an illness which causes our death. These have changed markedly over the years. For the pioneers, accidents, infections, childbirth were times and causes of great likelihood of death. A century ago, infections were the leading causes of death. Today, we will probably survive much longer than our ancestors but it is more likely we will die of heart disease, cancer or stroke. This is a dramatic change in the causes of death that has occurred over the years and with it is an equally dramatic change in the factors that predispose to those deaths.

The New England Journal of Medicine, arguably the most influential medical journal of our times, is celebrating its 200th year of publication with some special articles. A recent one called "The Burden of Disease and The Changing Task of Medicine" by Jones, Podolsky and Greene looked at the changes in causes of death from 1812 to today. The changes are not really surprising but worth contemplating. [Excellent graphs at the link.]

In 1812 the city of Boston recorded 992 deaths of which the greatest number by far were due to "consumption." Various other fevers combined were the next most common. Cancer killed five and sudden death (heart attacks?) took 25.

[snip]

As our population rapidly ages there will be increasing numbers of the chronic diseases that come with aging such as visual and hearing dysfunction, mobility problems, arthritis and Alzheimer's. And as society persists in eating a non-nutritious diet and too much of it, avoiding exercise, having chronic stress and (20%) smoking there will be literal epidemics of obesity, hypertension, coronary artery disease, stroke, chronic lung and kidney disease and cancer. Just as sanitation and vaccines made a huge impact on the diseases of a century ago, so too could aggressive preventive measures to assure health and wellness make a difference in this century.

What is evident is that the causes of death have switched from acute illnesses to chronic illnesses. And we know from insurance companies that chronic illnesses consume about 70-85% of claims paid. What is less well appreciated is that our medical care delivery system was established over the years to deal with acute illness and for one provider to care for one patient. In this regard, think of the internist who treats a pneumonia with an antibiotic or the surgeon who cures a patient by removing the appendix. But patients with complex chronic illnesses need not one doctor but a multi-specialist team to give the best possible care. And the team needs to be well coordinated, probably by the primary care physician or in the case of some situations by a specialist. In both circumstances the coordinator directs - orchestrates - the entire team to offer the patient the highest quality at the least expense. This is a change in how care is delivered that needs to fully occur as illnesses have increasingly become chronic, complex, life long, difficult to manage and expensive to treat.

This TEDx talk by Peter Saul summarizes the four ways we die out in plain, if uncomfortable detail.
I got the graph above showing the four main categories of causes of death from one of the power point slides in his talk. They are

Sudden Death

Terminal Illnesses

Organ Failure

Frailty

I may change my mind, but given a choice I would choose #1 or #2. Option #3 can be manageable in many cases but #4 definitely is the worst. Living longer doesn't mean a longer youth. Longevity means a longer old age.

2 comments:

Not so sure--seems as if frailty can in some cases be addressed with Ensure nutritional products and calcium treatments, cardio-rehab, weight training. I have seen it in elderly relatives now thriving. Even a pill derived from ingredients in tea can slow the decline of COPD--it is called Theophylline.And I am amazed how young active many retirees look.

Thanks for your comment. Good points.And what you say is correct, but it underscores the main point -- when protracted "frailty" is the pathway to the end the decline is extended. But at the end, regardless of the ultimate cause, the proximate cause will still have been frailty (as opposed to the other three categories).It's important not to conflate quality of life with cause of death. Although most candidates still don't take advantage of it, palliative care provides an excellent quality of life to the end. Likewise, frailty need not imply suffering or incapacity, only the famous traits of aging sans teeth, sans eyes, sans taste, sans everything. I have worked around several centenarians and have been amazed how little they looked "that" old, whatever that is.Take a look at How Doctors Die from a few days ago. And check the link to the video "Jim Cooper's Story."This post is aimed more at getting people to think about the subject than making limited categories.